High Body Fat Linked to 78% Greater Risk of Death—How to Know If You’re in Danger

Over 100 million U.S. adults are obese, and more than 22 million have severe obesity—that equates to more than two in five adults, according to the Centers for Disease Control and Prevention (CDC). Moreover, the World Health Organization (WHO) reports that adult obesity on a global scale has more than doubled since 1990.

Obesity alone can increase the chance of mortality, while also putting individuals at greater risk for other comorbidities, such as diabetes, heart disease, and some cancers. But new research says the way we measure obesity risk is outdated and results in misdiagnoses.

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BMI vs. body fat: How the measurements differ

Body fat percentage is “far more accurate” at predicting risk of heart disease and death than body mass index (BMI), according to a new research analysis published in the journal Annals of Family Medicine.

Researchers involved in the study “urged physicians to move away from BMI as the standard body composition measure,” per a news statement shared by University of Florida Health.

BMI measures “the ratio of your height to your weight to estimate the amount of body fat you have,” according to Cleveland Clinic. An “optimum” or healthy BMI range is 18.5 to 24.9. Someone is considered overweight if their BMI is between 25 to 29.9, and obese if they have a BMI of 30 or above.

A higher BMI typically indicates a higher amount of body fat. However, “BMI alone doesn’t diagnose health” and “it’s not accurate in some cases,” says the clinic.

Meanwhile, body fat percentage is determined using a bioelectrical impedance device. It “measures the electrical impedance of body tissues and can be used to assess fluid volumes, total body water, and fat-free body mass,” as explained in the study.

Lead researcher Arch Mainous, PhD, called body fat percentage a “practical alternative” for body mass index.

“One of the routine measures we take alongside traditional vital signs is BMI. We use BMI to sort of screen for a person having an issue with their body composition, but it’s not accurate for everyone like vital signs are,” said Mainous, who is also a professor and vice chair of research at the UF College of Medicine’s Department of Community Health and Family Medicine.

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BMI is more likely to miss health risks and misdiagnose people as obese.

One of the biggest hiccups with BMI is that it can’t differentiate muscle mass from fat mass. In other words, someone who is extremely muscular (like athletes or bodybuilders) could be under the impression that they’re “obese” due to a higher-than-normal BMI. But that would be inaccurate, because the BMI equation doesn’t account for muscle mass.

“Body mass index can potentially misclassify individuals with a muscular physique as overweight or obese,” wrote the authors. Moreover, patients with a “normal” BMI but “elevated” body fat percentage “may be unaware of their significantly increased risk of metabolic syndrome, type 2 diabetes, and cardiovascular disease.”

The team also noted that BMI categories “inaccurately predict both all-cause and cardiovascular mortality.”

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Research shows high body fat can significantly increase the risk of death.

A new study makes a strong case for using body fat percentage over BMI scores.

Researchers analyzed the health data of 4,252 adults, ages 20 to 49, from the National Health and Nutrition Examination Survey. They conducted a statistical analysis comparing body mass index to body fat percentage (the latter via a bioelectrical impedance device) to see which was more accurate at calculating 15-year mortality outcomes.

According to their results, there was only 60 percent overlap accuracy between the two measurements. Individuals with high body fat had a 78 percent greater risk of death. Additionally, they were at a 3.6 times increased risk of heart disease-caused mortality.

What’s more is that over the 15 years, high BMI was not linked to a significant risk of all-cause mortality. And there was no considerable link to death by heart disease, either.

The authors note that bioelectrical impedance scales are “inexpensive, reliable, valid, and can be easily integrated into a clinic setting.” (You might even see them in your gym—mine has one!)

“BMI is just so ingrained in how we think about body fat,” said Mainous. “I think the study shows it’s time to go to an alternative that is now proven to be far better at the job.”

The authors concluded: “This study demonstrates the value of a new and relatively unused measure of body composition to predict health risk…These results suggest rethinking how we should measure body composition in the clinical setting.”